The following guidance and practical advice for implementing the openIMIS software comes from the direct experiences of the Toumaï Community.

Planning and Preparations

When undertaking feasibility-scoping and early planning, the following key factors will help determine whether the circumstances are conducive for a successful implementation of openIMIS.

• Enabling environment for open-source. Many governments are reluctant to embrace technologies that use open-source software. Feasibility studies should consider any potential barriers to adopting open-source approaches. Project teams are encouraged to work with government agencies to address their concerns and gain support.

• Data-hosting. Many countries lack the capacity to host citizen data on secure servers. Nevertheless, many have enacted data-ownership policies that prevent the hosting of government/citizen data outside their territories. It may be necessary to host data on secure servers overseas, particularly during the implementation phase, so decisions around data-hosting need to be addressed from the outset.

• Demonstrable need. The value and necessity of an information management system needs to be understood, at all levels within implementing organization(s), for openIMIS to achieve maximum impact. Engagement and buy-in from management and staff are crucial at the implementation stage.

• User manual. A complete and up-to-date manual of procedures and specifications for the health insurance product is required, including clearly defined roles for all stakeholders. This level of clarity is vital to ensure a well-configured and widely adopted implementation of the software.

• Capacity and training. Key staff will require training in the operation and management of the software at the implementation stage. In addition, one or more dedicated administrators will be needed to manage access and input data on an ongoing basis. It is crucial to ensure that more than one member of staff is trained and familiar with the platform, to ensure access and use is not interrupted at any time.

• Computer equipment. Implementation of openIMIS requires one dedicated computer terminal for technical management (recording operations related to health insurance benefits, generation of public health indicators, monitoring and evaluation, etc.) and another computer terminal for administrative tasks including data input and management. In circumstances where the computer terminals used also operate significant software packages (e.g. DHIS2, EMR, Sage), an evaluation of capacity will be required. Additional desktop computers, laptops, tablets or smartphones are also necessary for offline operations, see below for minimum specifications.

• Technical infrastructure. Careful consideration needs to be given to the necessary technical infrastructure surrounding an implementation of openIMIS. Requirements include:

• A reliable electricity supply

• A stable internet connection to input transactions online and download entries made offline

• A mobile network coverage for communication between users (e.g. WhatsApp groups) particularly during blockages and internet outages

• Financial security. A sufficient operating budget, encompassing the overall structure using openIMIS, is essential. Ideally this will provide guaranteed funding for the initiative for a minimum of three years, allowing time for staff training, software implementation, monitoring and evaluation. Furthermore, where possible, the budget should allow for the payment of 'motivation bonuses' for users of the application, particularly during the early stages of implementation where efficiency gains are less visible or measurable.

Roles and Responsibilities

The stakeholders and actors surrounding the implementation of openIMIS will have various roles and responsibilities, as follows:

Government

• Ensuring the legislative environment is supportive of open-source applications and data-hosting.

• Allocating human resources within public structures using openIMIS.

• Maintaining interoperability of openIMIS with other software used at the national level.

• Providing the necessary equipment and infrastructure.

Insurance provider

• Allocating sufficient staff with the necessary skills to implement openIMIS, support, and manage users. A team of four people is recommended: IT specialist, risk assessor (with background in insurance and/or health finance), medical advisor, and monitoring and evaluation specialist.

National healthcare system/provider

• Dedicate a minimum of two staff members (per system) to operate openIMIS, plus hardware and infrastructure (i.e. computer, smartphones, electricity, internet).

Technical and financial partner

• Monitor the quality of responses provided by the system, and assess the suitability of these responses against the needs of the system.

• Provide financial support for equipment, training, accommodation, operating costs.

Developing a standard operating procedure

The key considerations, for principle actors and key stakeholders, to consider when defining the processes and developing a standard operating procedure (SOP) relate to the characteristics of the insurance product. These include the medical cover provided, prices, membership enrolment, contribution terms, services, co-payment, pricing, invoicing, management tools, etc.

Technical expertise

Optimal use of the openIMIS software requires specialized technical support during all stages of the implementation and throughout its operation. This will help to achieve maximum impact for the healthcare system. The technical support and expertise required is likely to include:

• In-depth initial training. Successful training programmes will need to ensure high-quality trainers and guest speakers, a carefully balanced training schedule, appropriate pedagogy, manageable trainee group sizes, sufficient infrastructure (training spaces, electricity, computer access, etc.), and appropriate teaching materials.

• Logs & record-keeping. Once established, openIMIS systems should incorporate a log book (physical or digital) to record usage, technical issues, challenges, and resolutions.

• Meetings and check-ups. Regular meetings should be scheduled for key staff to update and check-in with the technical support team. Proactive check-in sessions help to flag technical or operational issues early and ensure rapid resolution.

• Ongoing training. Regular refresher training sessions for all key staff, and training programmes for new recruits, are essential to ensure optimal use of the system throughout.

• Community support. Social media platforms (e.g. Facebook or WhatsApp) are a fast and effective way for users to share experiences and improve their own practice.

Enrolling beneficiaries

QR (quick response) codes are used to identify individuals enrolled into insurance programmes supported by openIMIS. Each user is assigned a unique number which is printed as a QR code on their membership card, at the point of enrolment. QR codes can be read by the enrolment officer or health facility staff using the openIMIS mobile app, saving time and reducing opportunities for errors. There are currently two approaches to providing membership cards to beneficiaries:
Pre-printed cards. Enrolment agents are provided membership cards with pre-printed QR codes. Beneficiary information is input into the openIMIS platform at point of enrolment — linking the member to the card and QR code — and the membership card is given to the beneficiary. This approach is fast and efficient, however, it is highly dependent on honest and professional enrolment agents.
Bespoke cards. Enrolment agents input the beneficiary information onto the openIMIS system, which generates a bespoke membership card and QR code. The cards are then posted/delivered to the members. Producing electronic cards (using chips rather than QR codes) is also possible when generating bespoke cards, however, there are significant cost implications. The bespoke approach is reliable — creating a card and code at the point of enrolment — but it takes longer for beneficiaries to receive their cards.

Hardware specifications

Minimum requirements for desktop and laptop:
Windows Server 2016
2 core CPU
8 GB RAM
100 GB Hard drive
Minimum requirements for smartphone or tablet:
Android 9
Processor 64 bit Quad core (Minimum A53, 1.0GHz)
512MB RAM
2GB storage